From the Guidelines
Allopurinol can generally be continued during the perioperative period without interruption. There is no strong evidence supporting the need to hold allopurinol before, during, or after surgery. Allopurinol is primarily used to treat gout and prevent uric acid kidney stones by inhibiting xanthine oxidase, which reduces uric acid production. Discontinuing allopurinol abruptly before surgery could potentially trigger gout flares in susceptible patients, which might complicate recovery. The medication does not significantly increase bleeding risk, does not interact with most anesthetic agents, and does not impair wound healing. However, if a patient is experiencing acute kidney injury or will undergo procedures with high risk of acute kidney injury, the surgical team might consider temporarily holding allopurinol since it can accumulate in renal impairment. Normal dosing can be resumed once the patient is stable postoperatively with adequate kidney function and oral intake. As with any medication management during surgery, the final decision should be made after considering the individual patient's specific circumstances, comorbidities, and the type of surgical procedure planned.
Some key points to consider when managing allopurinol in the perioperative period include:
- The risk of gout flares if allopurinol is discontinued abruptly 1
- The potential for allopurinol to accumulate in renal impairment and the need for dose adjustment in patients with kidney disease 1
- The lack of significant interactions between allopurinol and most anesthetic agents or impairment of wound healing 1
- The importance of individualizing medication management decisions based on the patient's specific circumstances and the type of surgical procedure planned 1
It's also important to note that the provided evidence does not directly address the management of allopurinol in the perioperative period, but rather provides general guidance on the management of antirheumatic medications and diabetes care in the hospital setting. However, based on the available evidence and general medical knowledge, it is reasonable to conclude that allopurinol can generally be continued during the perioperative period without interruption.
From the Research
Allopurinol in the Perioperative Period
- The decision to hold allopurinol in the perioperative period is complex and depends on various factors, including the patient's renal function and the risk of adverse reactions 2, 3.
- Patients with renal impairment are at increased risk of developing allopurinol hypersensitivity syndrome (AHS), a life-threatening condition characterized by a skin rash, fever, hepatitis, and worsening renal function 4, 3.
- The use of allopurinol in patients with renal insufficiency requires careful dose adjustment to avoid toxicity, with some studies suggesting that reduced doses may be effective in lowering uric acid levels while minimizing the risk of adverse reactions 5, 3.
- In the perioperative period, the risk of AHS and other adverse reactions may be increased due to factors such as dehydration, electrolyte imbalances, and the use of other medications that may interact with allopurinol 6.
- There is no clear consensus on whether allopurinol should be held in the perioperative period, and the decision should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 2, 5, 3.
Key Considerations
- Renal function: Patients with renal impairment are at increased risk of developing AHS and other adverse reactions, and dose adjustment may be necessary 2, 3.
- Dose adjustment: Reduced doses of allopurinol may be effective in lowering uric acid levels while minimizing the risk of adverse reactions in patients with renal insufficiency 5, 3.
- Monitoring: Close monitoring of serum uric acid levels, renal function, and liver function is essential in patients taking allopurinol, particularly in the perioperative period 2, 5.
- Alternative medications: In some cases, alternative medications such as febuxostat or benzbromarone may be considered for patients with gout who are at high risk of adverse reactions to allopurinol 5.